By Pam Marshalla
Q: My client is 7;0 and is being denied SL services because he has cognitive impairment and apraxia. The insurance company is saying that there is no evidence to demonstrate that he will improve because of his cognitive problems. Will he improve? Is there supportive research on this? Have you seen these kids improve? Children or adults with cognitive impairment bring unique challenges to the work of speech-language pathology. When reviewing the research in this area recently I found very…
By Pam Marshalla
Q: I have seen the Long T Method for teaching S on this blog and in your book “Frontal Lisp, Lateral Lisp” (Marshalla, 2007) as well as in the “Straight Up Speech” program by Jane Folk (Folk, 1992). I was wondering if you had to get permission from Jane for this, or if this method is in public domain? I made up that method just as I suspect Jane did. But it turns out that it is a very old…
By Pam Marshalla
Q: I am seeing a child who substitutes K for T. He can click his tongue, can touch the alveolar ridge adequately with his tongue, and he understands the tongue placement for T. But he is not able to raise his tongue tip to the alveolar ridge during his attempt to articulate T. He has good phonemic discrimination, too. The lingua-alveolar consonants emerge when the jaw begins to move up-and-down, not when the tongue moves. So begin by teaching the…
By Pam Marshalla
Q: My 12-year-old client is bright but has a lateral lisp. He has a gap between his side teeth. How can I tell if the dental gap is causing the lateral lisp, and how should I precede? I stuck cotton between the side teeth but it didn’t help. The dental problem may have contributed to the lisp, OR the lisp may have contributed to the dental problem. This is a chicken-and-egg situation that usually has no clear answer. But it doesn’t…
By Pam Marshalla
Q: I am an SLP who works with preschoolers, and my own daughter has a slight problem at age 18 months. I am getting frantic about this and need advice. She uses more than 50 words, is beginning to put two-word combinations together, and she has consonant phonemes from each manner group (a few stops, glides, nasals, and fricated sounds). She has all her vowels except those that require lip rounding, and I cannot seem to get her to round…
By Pam Marshalla
Q: I am working with a 5 year old boy who is unable to lingua-alveolar consonants except an occasional N in isolation and occasionally in the initial position of syllables. I am able to get the tongue placement for /t/ and /d/ but as soon as he tries to say the sound, he makes the /k/ or /g/. Any suggestions would be most appreciated! The anterior consonants T, D, N, L, S, Z come in because the jaw begins to…
By Pam Marshalla
Q: My son is 2.5 years old. He can say 6 words: Mom (ma), ball, up (uh), gone, please (pease), and truck. I am feeling overwhelmed with how to incorporate the 3 tracks of your “Vowel Tracks” material. Can I start with one track? He gets really frustrated with wanting stuff. I am getting worried he won’t talk. The purpose of Vowel Tracks is to show how to focus on vowels as new words are being added to a child’s…
By Pam Marshalla
Several questions have come in recently about how to get rid of hypernasality on a specific phoneme, particularly the hypernasal R and the nasal snort on one or more of the sibilants. I’d like to address these questions together… We are talking about clients who produce nasal emission on one or more specific phonemes in the absence of more generalized hypernasality. These clients sniff, snort, or allow some nasal sound to escape during production of their error phoneme(s). Peterson-Falzone and…
By Pam Marshalla
Q: My client lets air come out the side of his mouth when he makes Th. It’s not a big deal, but it is noticeable and distracting. This could be classified as a minor lateral lisp. The client is lacking the firm push of the side of his tongue against his side teeth that would prevent the airstream from staying midline. I would use a straw. Place one end of the straw outside the central incisors and tell him the…
By Pam Marshalla
Q: My 19-month-old cannot produce O. She is smart and has no other speech or developmental problems, but it interferes with intelligibility. My guess is that your daughter will learn to round her lips within a few weeks or months all on her own without any help. She is only one year old and has lots of time to gain this simple skill. If you were to come to my office about this, and this was the only problem, I…
